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COVID-19 Student Testing Consent Form
Please read the associated letter and terms of consent before completing this form.
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* Indicates required question
Email
*
Your email
Student's First Name
*
Your answer
Student's Surname
*
Your answer
Tutor Group
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Name of Parent/Guardian giving consent
*
Your answer
Relationship to test subject
*
Your answer
Details of any health or accessibility issues which might affect a child’s safe participation in the testing exercise.
Your answer
Do you give consent for the testing?
*
YES - I consent & I confirm that I have read and agree with the terms of consent and am happy for the student named above to participate in the COVID-19 testing program outlined in the letter
NO - I do not consent
Signature (please type your name)
*
Your answer
Please check all information is accurate before submitting. If you wish to change your response or withdraw consent at any time please email
nocv19@hccs.info
Send me a copy of my responses.
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